Scientific justification Candidemia is a major public health problem. In France, the 30-day mortality of candidemia varies from 30% to 50% depending on the need for intensive care and it has not decreased in 30 years. The duration of treatment for candidemia was set at a minimum of 14 days after the last positive blood culture following the Rex trial (1) comparing the efficacy of fluconazole vs amphotericin B where the minimum duration of treatment was imposed. The risk of a too short treatment is the absence of control of the candidemia with secondary dissemination, in particular cardiac and ophthalmic. A retrospective study looking at the risk of ophthalmologic complications after candidemia found among the 21/78 treated for less than 14 days, only one case of late endophthalmitis in a patient who had only been treated for 48 hours. In addition, the prolonged duration of antifungals exposes the risk of selection of more resistant strains with a modification of the flora, with the possibility of acquiring resistance as early as 8 days of treatment with caspofungin, and has a greater liver toxicity. There is no prospective study on the direct impact of antifungal agents (type of antifungal agent and duration) on the mycobiota.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
362
14 days of antifungal therapy after the 1st negative blood culture
7 days of antifungal therapy after the 1st negative blood culture
All-cause mortality (ACM)
at day 28 after the 1st negative blood culture under antifungal treatment for all patients included with an uncomplicated candidemia
Time frame: At day 28
Proportion of patients with secondary localizations
Time frame: At day 28
Cumulative incidence of death related to fungal infection
at Day 28 after the 1st negative blood culture under antifungal treatment
Time frame: At day 28
Aspartate Amino-transferase level
Time frame: At day 14
Aspartate Amino-transferase level
Time frame: At day 28
alanine aminotransférase (ALAT) level
Time frame: At day 14
alanine aminotransférase (ALAT) level
Time frame: At day 28
Gamma-Glutamyl Transférase (GGT) level
Time frame: At day 14
Gamma-Glutamyl Transférase (GGT) level
Time frame: At day 28
Bilirubin blood levels
Time frame: At day 14
Bilirubin blood levels
Time frame: At day 28
Cost per extra-day alive without antifungal treatment
Incremental cost effectiveness ratio
Time frame: Up to day 28
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